Pain Control Options in Palliative Care: Special Considerations for Children

ISSN： 1175-6357

Source： American Journal of Cancer, Vol.4, Iss.2, 2005-01, pp. : 77-85

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Abstract

Although pain management is one of many domains in the care of the dying child, pain is a common symptom which needs to be prioritized and treated meticulously. Pain may be caused by the underlying illness or adverse effects related to medical interventions and treatment, or may be unrelated to either the primary disease or its treatment. Pain assessment should be considered in the light of an overall symptom burden, which can be a matrix of physical, psychologic, social, and spiritual parameters. The assessment and diagnosis of pain is fundamental to the clinical care of dying children since therapies directed at the primary cause may ultimately have a more effective pain management outcome. A dying childs symptomatology may linger for a long time in the memory of parents and caregivers. Indeed, pain is one of the most feared and distressing symptoms not only to children with cancer receiving palliative care, but also their families.Pain control options for children with cancer consist of pharmacologic and non-pharmacologic options. The emphasis in this article is on pharmacologic options. Analgesic prescription is based on pain severity assessment: simple analgesics for mild pain and opioids for severe pain. In children, the simplest route of administration for analgesics (oral administration) is recommended and the intramuscular route should be avoided. There are few data on the prescription of adjuvant analgesics in children, with most data from adult studies. Adjuvant analgesic prescription in children tends to be confined to the anticonvulsants and antidepressants. The vast majority of children have satisfactory analgesia using conventional doses of opioids; and only a minority require massive opioid doses or invasive approaches.